Ischemia and perioperative infarction
Perioperative medicine has provided anesthetists with a proactive role in the prevention of perioperative compli cations, in particular cardiovascular events such as myocardial injury after non-cardiac surgery.
Using cardiovascular risk concepts, pre-operative assessment for non-cardiac surgery, optimization of the hemo-dynamic status, determination of differences between elective and urgent patients, monitoring, close follow-up after surgery, and measurements of ultrasensitive troponin in the first 48 hours postoperatively, anesthetists are now able to identify and address early clinical manifestations of perioperative ischemia and myocardial infarction (MI) in patients at risk.
Materials and methods:
Narrative review: Queries in various databases on perioperative ischemia and non-fatal infarction in Pubmed, Science Direct, and Ovid.
The analysis of cardiac troponin levels is of the utmost importance in the prognosis of perioperative MI. Diagnosis can be made earlier, and it has been shown that the majority of these perioperative events have their onset within the first 48 hours of the postoperative period, when the physiological stress is highest in patients taken to non-cardiac surgery.
2. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, et al. POISE Study Group. Effects on extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE Trial): a randomised controlled trial. Lancet 2008;371:1839-1847.
3. Rodseth RN, Biccard BM, Manach YL, Sessler DI, Lurati Buse G, Thabane L, et al. The prognostic value of the pre-operative and post-operative B-Type natriuretic peptides in patients undergoing noncardiac surgery. A systematic review and individual patient data meta-analysis. JACC 2014;63:170-180.
4. Anderson JL, Morrow DA. Acute Myocardial Infarction. N Engl J Med 2017;376:2053-2064.
5. Chapman AR, Adamson PD, Mills NL. Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart 2017;103:10-18.
6. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. NEJM 2015;373:2258-2269.
7. Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors,;1; and 30-day outcomes. Anesthesiology 2014;120:564-567.
8. Sabate S, Mases A, Guilera N, Canet J, Castillo J, Orrego C, et al. Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery. Br J Anaesth 2011;107:879-890.
9. Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011;124: 381-387.
10. Sessler DI, Devereaux PJ. Perioperative Troponin Screening. Anesth Analg 2016;123:359-360.
11. Deveraux PJ, Xavier D, Pogue J, Guyatt G, Carutti I, Leslie K. Characteristics and short-term prognosis of perioperative myo-cardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 2011;154:523-528.
12. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation 1995;92:657-671.
13. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. On behalf of the Joint ESC/ACCF/AHA/ WHF Task Force for the Redefinition of Myocardial Infarction. Circulation 2007;116:2634-2653.
14. Eggers KM. Defining acute myocardial infarction. Heart Metab 2015;67:34-38.
15. Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. JAMC 2005;175:627-634.
16. Grobben RB, Van Klei WA, Grobbee DE, Nathoe HN. The aetiology of myocardial injury after non-cardiac surgery. Neth Heart J 2013;21:380-388.
17. Cohn SL, Dutta S, Slawski BA, Grant PJ, Smetana GW. Update in perioperative cardiac medicine. Cleve Clin J Med 2016;83: 723-730.
18. Fleisher LE, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary. JACC 2007;50:1707-1732.
19. Mauck KF, Manjarrez EC, Cohn SL. Cardiac evaluation: assessment, risk reduction, and complication management. Clin Geriatr Med 2008;24:585-605.
20. Van Waes JAR, Grobben RB, Nathoe HM, Kemperman H, De Borst GJ, Peelen LM, et al. One-Year Mortality, Causes of Death, and Cardiac Interventions in Patients with Postoperative Myocardial Injury. Anesth Analg 2016;123:29-37.
21. Maile MD, Jewell ES, Engoren MC. Timing of Preoperative Troponin Elevations and Postoperative Mortality after Noncardiac Surgery. Anesth Analg 2016;123:135-140.
22. Ramakrishna H, Pagel PS. Preoperative Troponin in Patients Undergoing Noncardiac Surgery: Is Timing Everything? Anesth Analg 2016;123:2-4.
23. Mauermann E, Puelacher C, Lurati Buse G. Myocardial injury after noncardiac surgery: an underappreciated problem and current challenges. Curr Opin Anaesthesiol 2016;29:403-412.
24. Puelachera C, Lurati-Busea G, Singeisena H, Danga M, Cuculib F, Muellera C. Perioperative myocardial infarction/injury after noncardiac surgery. Swiss Med Wkly 2015;145:w14219.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.